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Atrial Arrhythmias: Diagnosis, Management and Future Opportunities
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Atrial Arrhythmias: Diagnosis, Management and Future Opportunities

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (10 January 2025) | Viewed by 4722

Special Issue Editor

Dr. Sergio Conti

E-Mail Website
Guest Editor
Department of Electrophysiology, ARNAS Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
Interests: atrial fibrillation; atrial fibrillation ablation; catheter ablation; ablation technologies; mapping
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This is a formal invitation to be part of a new Special Issue of the Journal of Clinical Medicine. The title is self-explanatory: “Atrial Arrhythmias: Diagnosis, Management and Future Opportunities”. Due to the technological advancements in diagnostic tools and better clinical knowledge of pathophysiology, we are rethinking old concepts and facing new topics every single day. The consolidation and widespread use of newer and more advanced mapping as well as ablation technologies of atrial arrhythmias have substantially contributed to the growing interest in this field.

Among the several topics of interest, we would like to focus on the mapping and ablation of atrial arrhythmias, particularly focusing on post-AF ablation atrial arrhythmias’ mapping and ablation aspects.

Therefore, the aim of this Special Issue is to provide JCM readers with an update on the pathophysiology, diagnosis, and treatment of atrial arrhythmias.

Dr. Sergio Conti
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • atrial fibrillation ablation
  • atrial tachycardia
  • atrial flutter
  • redo
  • repeat ablation
  • 3D mapping
  • mapping technolo-gies and techniques

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Published Papers (4 papers)

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Research

13 pages, 1151 KiB  
Article
Continuous Monitoring with Implantable Loop Recorders After Cryoballoon Ablation: Impact on Atrial Fibrillation Recurrence and Therapeutic Management in Era of Artificial Intelligence
by Rosario Foti, Michele Di Silvestro, Giuseppe Campisi, Sergio Conti, Giuseppe Picciolo, Carlo Cardì, Marco Barbanti, Giulia Rapisarda, Antonio Parlavecchio and Giuseppe Sgarito
J. Clin. Med. 2025, 14(9), 2932; https://doi.org/10.3390/jcm14092932 - 24 Apr 2025
Viewed by 219
Abstract
Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia associated with stroke, heart failure, and increased mortality. Due to its efficacy and safety, cryoballoon ablation (CBA) is widely accepted for rhythm control; however, long-term AF recurrence remains a challenge. Continuous monitoring [...] Read more.
Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia associated with stroke, heart failure, and increased mortality. Due to its efficacy and safety, cryoballoon ablation (CBA) is widely accepted for rhythm control; however, long-term AF recurrence remains a challenge. Continuous monitoring with implantable loop recorders (ILRs) enhanced by artificial intelligence (AI) can detect both symptomatic and asymptomatic episodes, potentially optimizing patient management. This analysis assessed the long-term effectiveness of CBA in maintaining sinus rhythm and investigated the role of ILR-guided monitoring in enhancing therapeutic decisions. Methods: Data from 91 patients with paroxysmal or persistent atrial fibrillation (AF) who underwent pulmonary vein isolation using cryoballoon ablation at four Italian centers between April 2022 and April 2024 were analyzed. All patients received an insertable loop recorder (ILR) before or during hospitalization for ablation, allowing for the continuous remote monitoring of arrhythmias. Baseline demographics, procedural details, AF occurrence, AF burden (calculated as the total duration of all AF episodes occurring within a day and categorized by episode duration), therapeutic adjustments, and the effect of artificial intelligence (AI) on data processing were evaluated. Results: The cohort’s average age was 62.4 years, with 24.2% of participants being female. Physician-confirmed AF recurrence was noted in 26.7% of patients at 12 months and 49.5% at 24 months. The device data indicated a daily AF burden of ≥6 min in 47.2% at 12 months, with 25.9% surpassing 1 h. AI algorithms decreased false-positive alerts by 21%, resulting in an estimated saving of 19 clinician hours. In patients with pre-ablation ILR data, the median AF burden significantly decreased from 7% to 0.2% (p = 0.017). ILR-guided monitoring affected treatment adjustments, leading to the discontinuation of antiarrhythmic therapy in 36 patients and redo ablations in 8. Conclusions: Continuous ILR monitoring, combined with AI-driven analysis, enables the detection of AF recurrences and burden, thereby facilitating timely therapeutic adjustments. Full article
(This article belongs to the Special Issue Atrial Arrhythmias: Diagnosis, Management and Future Opportunities)
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14 pages, 1011 KiB  
Article
Evaluation of Serum Soluble Lectin-like Oxidised Low-Density Lipoprotein Receptor-1 (sLOX-1) Level in Children with Non-Complicated Type-1 Diabetes Mellitus (T1DM) and Its Relationship with Carotid Intima Media Thickness (cIMT)
by Sukriye Ozde, Fatma Yavuzyilmaz, Mehmet Ali Ozel, Osman Kayapinar, Cem Ozde, Gulsah Akture and Ilknur Arslanoglu
J. Clin. Med. 2025, 14(3), 935; https://doi.org/10.3390/jcm14030935 - 31 Jan 2025
Viewed by 719
Abstract
Background: The objective of this study was to evaluate serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) levels in children with type-1 diabetes mellitus (T1DM) without any atherosclerotic complications and to investigate whether there was an association with early atherosclerotic processes in [...] Read more.
Background: The objective of this study was to evaluate serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) levels in children with type-1 diabetes mellitus (T1DM) without any atherosclerotic complications and to investigate whether there was an association with early atherosclerotic processes in these children. Methods: The study’s design entailed a prospective cross-sectional observational study methodology. The patient group consisted of 80 consecutive children aged 8–18 years who had been diagnosed with T1DM for at least ten years and had not developed any chronic clinical complications related to T1DM. The control group consisted of 72 completely healthy children with similar demographic characteristics. Serum levels of sLOX-1 were measured, and carotid intima-media thickness (cIMT) was evaluated using ultrasonography in all subjects. Results: A statistical analysis of the results was conducted. The serum sLOX-1 level was found to be significantly higher in the patient group than in the control group (0.49 ± 0.11 vs. 0.82 ± 0.35; p < 0.001). The statistical significance observed was maintained in the multivariable logistic regression analysis (p < 0.001). A significant correlation was identified between cIMT and serum sLOX-1 levels (r = 0.669, p < 0.001). The receiver operating characteristic curve for sLOX-1 indicated that a cutoff value greater than 0.65 ng/mL was associated with T1DM. Conclusions: Serum sLOX-1 levels were markedly elevated in children with T1DM who had not yet manifested chronic complications. These findings suggest that elevated serum sLOX-1 levels may be associated with the progression of atherosclerosis in children with T1DM. Full article
(This article belongs to the Special Issue Atrial Arrhythmias: Diagnosis, Management and Future Opportunities)
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10 pages, 1998 KiB  
Article
CT-Assessment of Epicardial Fat Identifies Increased Inflammation at the Level of the Left Coronary Circulation in Patients with Atrial Fibrillation
by Renáta Gerculy, Imre Benedek, István Kovács, Nóra Rat, Vasile Bogdan Halațiu, Ioana Rodean, Lehel Bordi, Emanuel Blîndu, Aurelian Roșca, Botond-Barna Mátyás, Evelin Szabó, Zsolt Parajkó and Theodora Benedek
J. Clin. Med. 2024, 13(5), 1307; https://doi.org/10.3390/jcm13051307 - 26 Feb 2024
Cited by 1 | Viewed by 1541
Abstract
Background: Atrial fibrillation (AF) can often be triggered by an inflammatory substrate. Perivascular inflammation may be assessed nowadays using coronary computed tomography angiography (CCTA) imaging. The new pericoronary fat attenuation index (FAI HU) and the FAI Score have prognostic value for predicting future [...] Read more.
Background: Atrial fibrillation (AF) can often be triggered by an inflammatory substrate. Perivascular inflammation may be assessed nowadays using coronary computed tomography angiography (CCTA) imaging. The new pericoronary fat attenuation index (FAI HU) and the FAI Score have prognostic value for predicting future cardiovascular events. Our purpose was to investigate the correlation between pericoronary fat inflammation and the presence of AF among patients with coronary artery disease. Patients and methods: Eighty-one patients (mean age 64.75 ± 7.84 years) who underwent 128-slice CCTA were included in this study and divided into two groups: group 1 comprised thirty-six patients with documented AF and group 2 comprised forty-five patients without a known history of AF. Results: There were no significant differences in the absolute value of fat attenuation between the study groups (p > 0.05). However, the mean FAI Score was significantly higher in patients with AF (15.53 ± 10.29 vs. 11.09 ± 6.70, p < 0.05). Regional analysis of coronary inflammation indicated a higher level of this process, especially at the level of the left anterior descending artery (13.17 ± 7.91 in group 1 vs. 8.80 ± 4.75 in group 2, p = 0.008). Conclusions: Patients with AF present a higher level of perivascular inflammation, especially in the region of the left coronary circulation, and this seems to be associated with a higher risk of AF development. Full article
(This article belongs to the Special Issue Atrial Arrhythmias: Diagnosis, Management and Future Opportunities)
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15 pages, 1557 KiB  
Article
Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry
by Tommaso Bucci, Katarzyna Nabrdalik, Alena Shantsila, Giulio Francesco Romiti, Wee-Siong Teo, Hyung-Wook Park, Wataru Shimizu, Hung-Fat Tse, Marco Proietti, Tze-Fan Chao, Gregory Y. H. Lip and Asia-Pacific Heart Rhythm Society Atrial Fibrillation Registry Investigators
J. Clin. Med. 2024, 13(5), 1274; https://doi.org/10.3390/jcm13051274 - 23 Feb 2024
Cited by 2 | Viewed by 1616
Abstract
Aims. To evaluate the adverse events (and its clinical correlates) in a large prospective cohort of Asian patients with atrial fibrillation (AF) and diabetes mellitus (DM). Material and Methods. We recruited patients with atrial fibrillation (AF) from the Asia-Pacific Heart Rhythm Society (APHRS) [...] Read more.
Aims. To evaluate the adverse events (and its clinical correlates) in a large prospective cohort of Asian patients with atrial fibrillation (AF) and diabetes mellitus (DM). Material and Methods. We recruited patients with atrial fibrillation (AF) from the Asia-Pacific Heart Rhythm Society (APHRS) AF Registry and included those for whom the diabetic mellitus (DM) status was known. We used Cox-regression analysis to assess the 1-year risk of all-cause death, thromboembolic events, acute coronary syndrome, heart failure and major bleeding. Results. Of 4058 patients (mean age 68.5 ± 11.8 years; 34.4% females) considered for this analysis, 999 (24.6%) had DM (age 71 ± 11 years, 36.4% females). Patients with DM had higher mean CHA2DS2-VASc (2.3 ± 1.6 vs. 4.0 ± 1.5, p < 0.001) and HAS-BLED (1.3 ± 1.0 vs. 1.7 ± 1.1, p < 0.001) risk scores and were less treated with rhythm control strategies compared to patients without DM (18.7% vs. 22.0%). After 1-year of follow-up, patients with DM had higher incidence of all-cause death (4.9% vs. 2.3%, p < 0.001), cardiovascular death (1.3% vs. 0.4%, p = 0.003), and major bleeding (1.8% vs. 0.9%, p = 0.002) compared to those without DM. On Cox regression analysis, adjusted for age, sex, heart failure, coronary and peripheral artery diseases and previous thromboembolic event, DM was independently associated with a higher risk of all-cause death (HR 1.48, 95% CI 1.00–2.19), cardiovascular death (HR 2.33, 95% CI 1.01–5.40), and major bleeding (HR 1.91, 95% 1.01–3.60). On interaction analysis, the impact of DM in determining the risk of all-cause death was greater in young than in older patients (p int = 0.010). Conclusions. Given the high rates of adverse outcomes in these Asian AF patients with DM, efforts to optimize the management approach of these high-risk patients in a holistic or integrated care approach are needed. Full article
(This article belongs to the Special Issue Atrial Arrhythmias: Diagnosis, Management and Future Opportunities)
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